HRSA 2023 Uniform Data System (UDS) Patient Level Submission (PLS) (UDS+) FHIR IG
1.0.1 - STU1 Release 1 - Standard for Trial-Use
This page is part of the HRSA Uniform Data System (UDS) Patient Level Submission (PLS) (UDS+ or uds-plus) FHIR IG (v1.0.1: STU1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
Official URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-coverage | Version: 1.0.1 | |||
Standards status: Trial-use | Maturity Level: 2 | Computable Name: DeIdentifiedUDSPlusCoverage |
The UDS+ profile establishes the core elements, extensions, vocabularies and value sets for representing Coverage for UDS+ program.
This profile is used to represent de-identified Coverage information. The de-identification process has to remove all data elements not explicitly identified as “SUPPORTED” in the profile.
The HHS De-identification Guidance is to be followed to ensure appropriate level of de-identification is performed.
According to the HHS guidance, dates should not have a precision of more than the year. This means month and day cannot be included. This includes Coverage.period.
In FHIR Resources, text elements and reference.display elements which provide human readable information to the providers may be generated using programs and tools from the data present within the resource. For e.g a Coverage resource text element may contain information such as the Coverage date, beneficiary information. This type of information will enable identification of the individuals. In order to avoid inadvertent revealing of PII/PHI, text elements cannot be included in the De-identified FHIR resource and the submission will be rejected when text elements are present by the validation process.
Ids and References
The original Coverage resource id should not be included in the De-identified Coverage instance. Instead a new id should be created and provided as part of the FHIR resource. The Data Submitter should be capable of using the generated id to relink the data to the original Coverage. All resource references to the Coverage submitted as part of the UDS+ report should refer to newly generated id.
Resource references cannot contain text element as it may contain PHI/PII. The text element for following references are not allowed
Date Truncation
The Data Submitter has to truncate the following dates to only have a precision of year
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | UDS Plus Coverage | |
id | S | 0..1 | id | The de-identified Coverage identifier created by the health center to send data to HRSA. |
text | 0..0 | |||
contained | 0..0 | |||
capitatedMemberMonths | S | 0..1 | Quantity | Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension |
feeForServiceMemberMonths | S | 0..1 | Quantity | Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension |
status | S | 1..1 | code | active | cancelled | draft | entered-in-error Fixed Value: active |
type | S | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting. |
text | 0..0 | |||
beneficiary | S | 1..1 | Reference(De-Identified UDS Plus Patient) | Plan beneficiary |
display | 0..0 | |||
period | S | 0..1 | Period | Coverage start and end dates |
payor | S | 1..* | Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) | Issuer of the policy |
display | 0..0 | |||
Documentation for this format |
Path | Conformance | ValueSet |
Coverage.type | extensible | UdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes) |
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | UDS Plus Coverage | |
id | SΣ | 0..1 | id | The de-identified Coverage identifier created by the health center to send data to HRSA. |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
capitatedMemberMonths | S | 0..1 | Quantity | Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension |
feeForServiceMemberMonths | S | 0..1 | Quantity | Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active |
type | SΣ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting. |
beneficiary | SΣ | 1..1 | Reference(De-Identified UDS Plus Patient) | Plan beneficiary |
period | SΣ | 0..1 | Period | Coverage start and end dates |
payor | SΣ | 1..* | Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) | Issuer of the policy |
Documentation for this format |
Path | Conformance | ValueSet / Code |
Coverage.status | required | Fixed Value: active |
Coverage.type | extensible | UdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes) |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
Coverage | 0..* | Coverage | UDS Plus Coverage | |||||
id | SΣ | 0..1 | id | The de-identified Coverage identifier created by the health center to send data to HRSA. | ||||
meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
capitatedMemberMonths | S | 0..1 | Quantity | Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension | ||||
feeForServiceMemberMonths | S | 0..1 | Quantity | Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension | ||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
identifier | Σ | 0..* | Identifier | Business Identifier for the coverage | ||||
status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active | ||||
type | SΣ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | Σ | 0..* | Coding | Code defined by a terminology system | ||||
policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
subscriberId | Σ | 0..1 | string | ID assigned to the subscriber | ||||
beneficiary | SΣ | 1..1 | Reference(De-Identified UDS Plus Patient) | Plan beneficiary | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
dependent | Σ | 0..1 | string | Dependent number | ||||
relationship | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
period | SΣ | 0..1 | Period | Coverage start and end dates | ||||
payor | SΣ | 1..* | Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) | Issuer of the policy | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
class | 0..* | BackboneElement | Additional coverage classifications | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. | ||||
value | Σ | 1..1 | string | Value associated with the type | ||||
name | Σ | 0..1 | string | Human readable description of the type and value | ||||
order | Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
network | Σ | 0..1 | string | Insurer network | ||||
costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified. | ||||
value[x] | Σ | 1..1 | The amount or percentage due from the beneficiary | |||||
valueQuantity | Quantity(SimpleQuantity) | |||||||
valueMoney | Money | |||||||
exception | 0..* | BackboneElement | Exceptions for patient payments | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 1..1 | CodeableConcept | Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays. | ||||
period | Σ | 0..1 | Period | The effective period of the exception | ||||
subrogation | 0..1 | boolean | Reimbursement to insurer | |||||
contract | 0..* | Reference(Contract) | Contract details | |||||
Documentation for this format |
Path | Conformance | ValueSet / Code | ||||
Coverage.language | preferred | CommonLanguages
| ||||
Coverage.status | required | Fixed Value: active | ||||
Coverage.type | extensible | UdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes) | ||||
Coverage.beneficiary.type | extensible | ResourceType | ||||
Coverage.relationship | extensible | SubscriberRelationshipCodes | ||||
Coverage.payor.type | extensible | ResourceType | ||||
Coverage.class.type | extensible | CoverageClassCodes | ||||
Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodes | ||||
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodes |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from Coverage
Summary
Mandatory: 1 element
Must-Support: 8 elements
Fixed Value: 1 element
Prohibited: 5 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Maturity: 2
Differential View
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | UDS Plus Coverage | |
id | S | 0..1 | id | The de-identified Coverage identifier created by the health center to send data to HRSA. |
text | 0..0 | |||
contained | 0..0 | |||
capitatedMemberMonths | S | 0..1 | Quantity | Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension |
feeForServiceMemberMonths | S | 0..1 | Quantity | Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension |
status | S | 1..1 | code | active | cancelled | draft | entered-in-error Fixed Value: active |
type | S | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting. |
text | 0..0 | |||
beneficiary | S | 1..1 | Reference(De-Identified UDS Plus Patient) | Plan beneficiary |
display | 0..0 | |||
period | S | 0..1 | Period | Coverage start and end dates |
payor | S | 1..* | Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) | Issuer of the policy |
display | 0..0 | |||
Documentation for this format |
Path | Conformance | ValueSet |
Coverage.type | extensible | UdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes) |
Key Elements View
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Coverage | 0..* | Coverage | UDS Plus Coverage | |
id | SΣ | 0..1 | id | The de-identified Coverage identifier created by the health center to send data to HRSA. |
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
capitatedMemberMonths | S | 0..1 | Quantity | Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension |
feeForServiceMemberMonths | S | 0..1 | Quantity | Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension |
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active |
type | SΣ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting. |
beneficiary | SΣ | 1..1 | Reference(De-Identified UDS Plus Patient) | Plan beneficiary |
period | SΣ | 0..1 | Period | Coverage start and end dates |
payor | SΣ | 1..* | Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) | Issuer of the policy |
Documentation for this format |
Path | Conformance | ValueSet / Code |
Coverage.status | required | Fixed Value: active |
Coverage.type | extensible | UdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes) |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints | ||||
---|---|---|---|---|---|---|---|---|
Coverage | 0..* | Coverage | UDS Plus Coverage | |||||
id | SΣ | 0..1 | id | The de-identified Coverage identifier created by the health center to send data to HRSA. | ||||
meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
capitatedMemberMonths | S | 0..1 | Quantity | Indicates the capitated member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-capitated-member-months-extension | ||||
feeForServiceMemberMonths | S | 0..1 | Quantity | Indicates the FeeForService member months of the Patient. URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-feeforservice-member-months-extension | ||||
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
identifier | Σ | 0..* | Identifier | Business Identifier for the coverage | ||||
status | ?!SΣ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Fixed Value: active | ||||
type | SΣ | 1..1 | CodeableConcept | Coverage category such as medical or accident Binding: Uds Plus Insurance Codes (extensible): The set of codes to be used for UDS+ reporting. | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
coding | Σ | 0..* | Coding | Code defined by a terminology system | ||||
policyHolder | Σ | 0..1 | Reference(Patient | RelatedPerson | Organization) | Owner of the policy | ||||
subscriber | Σ | 0..1 | Reference(Patient | RelatedPerson) | Subscriber to the policy | ||||
subscriberId | Σ | 0..1 | string | ID assigned to the subscriber | ||||
beneficiary | SΣ | 1..1 | Reference(De-Identified UDS Plus Patient) | Plan beneficiary | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
dependent | Σ | 0..1 | string | Dependent number | ||||
relationship | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
period | SΣ | 0..1 | Period | Coverage start and end dates | ||||
payor | SΣ | 1..* | Reference(De-Identified UDS Plus Patient | US Core Organization Profile | De-Identified UDS Plus RelatedPerson) | Issuer of the policy | ||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
reference | ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
class | 0..* | BackboneElement | Additional coverage classifications | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. | ||||
value | Σ | 1..1 | string | Value associated with the type | ||||
name | Σ | 0..1 | string | Human readable description of the type and value | ||||
order | Σ | 0..1 | positiveInt | Relative order of the coverage | ||||
network | Σ | 0..1 | string | Insurer network | ||||
costToBeneficiary | 0..* | BackboneElement | Patient payments for services/products | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 0..1 | CodeableConcept | Cost category Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified. | ||||
value[x] | Σ | 1..1 | The amount or percentage due from the beneficiary | |||||
valueQuantity | Quantity(SimpleQuantity) | |||||||
valueMoney | Money | |||||||
exception | 0..* | BackboneElement | Exceptions for patient payments | |||||
id | 0..1 | string | Unique id for inter-element referencing | |||||
extension | 0..* | Extension | Additional content defined by implementations | |||||
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
type | Σ | 1..1 | CodeableConcept | Exception category Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays. | ||||
period | Σ | 0..1 | Period | The effective period of the exception | ||||
subrogation | 0..1 | boolean | Reimbursement to insurer | |||||
contract | 0..* | Reference(Contract) | Contract details | |||||
Documentation for this format |
Path | Conformance | ValueSet / Code | ||||
Coverage.language | preferred | CommonLanguages
| ||||
Coverage.status | required | Fixed Value: active | ||||
Coverage.type | extensible | UdsPlusInsuranceCodes (a valid code from UDS Plus Insurance Codes) | ||||
Coverage.beneficiary.type | extensible | ResourceType | ||||
Coverage.relationship | extensible | SubscriberRelationshipCodes | ||||
Coverage.payor.type | extensible | ResourceType | ||||
Coverage.class.type | extensible | CoverageClassCodes | ||||
Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodes | ||||
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodes |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from Coverage
Summary
Mandatory: 1 element
Must-Support: 8 elements
Fixed Value: 1 element
Prohibited: 5 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Maturity: 2
Other representations of profile: CSV, Excel, Schematron